Randomized Trial ACTH vs Dexamethasone In Mechanically Ventilated VLBW Infants 1707

Abstract

Background: BPD is a chronic lung disease often occuring in ventilator treated VLBW infants. Several studies demonstrate the role of pro-inflammatory cytokines and their reduction after corticosteroid treatment. Because of adverse effects of dexamethasone, we tried a new therapeutic approach using ACTH, that seems to imply less severe side effects.Aim: To compare the antiinflammatory action and side effects of ACTH and dexamethasone in VLBW infants by measuring IL6 and a-MSH, known as an endogenous anti-inflammatory agent. Population: We enrolled 14 VLBW infants, mean GA 29.2 wks (range 26-32 wks) and mean BW 1135 g (range 570-1810), mechanically ventilated for RDS. At 6th day of life neonates were randomized into 2 groups: group A (n=7) received dexamethasone (0.5mg/kg per day for 3 days) and group B (n=7) received ACTH (Synacthen 150 mcg/m2 per day for 3 days). The 2 groups had similar clinical characteristics before treatment (GA, BW, OI, AaDO2) (p=NS). Blood levels of IL6 and a-MSH were evaluated in 1st, 3rd, 6th, 10th and 15th day of life. Results: IL6 maximum levels were observed on the 1st day of life in group A (67.68±71.6 pg/ml) and on the 3rd day of life in group B (53.17±82 pg/ml). On the 10th day of life IL-6 reached minimum levels in both groups(A:10.82±18.1 pg/ml; B:5.94±5.9 pg/ml), while a-MSH reached maximum levels (A: 26.38±10.8 pg/ml; B:22.71±5.4 pg/ml). Both groups showed a significant (p<0.05) but transient rise of blood pressure; hyperglycemia and myocardial hypertrophy were not observed. BPD occurred in 3 infants in both groups.